Drug Interactions between bupivacaine / hydromorphone and bupivacaine liposome

BUPivacaine liposome is a specially formulated anesthetic that releases the medication into the surrounding tissue at a controlled rate. When exposed to other local anesthetic solutions, the release rate can be altered. Depending on the dose of BUPivacaine relative to BUPivacaine liposome, mixing these medications together or injecting them into the same area at the same time may cause rapid release of the active medication and alter the safety and efficacy of BUPivacaine liposome. In general, additional use of local anesthetics including BUPivacaine should be avoided within 96 hours following administration of BUPivacaine liposome. If necessary, BUPivacaine and BUPivacaine liposome may be given simultaneously in the same syringe, or BUPivacaine may be injected immediately before BUPivacaine liposome, as long as the ratio of the milligram dose of BUPivacaine to BUPivacaine liposome does not exceed 1:2. However, because the toxic effects of these medications are additive, using them together requires caution and constant monitoring of vital signs and state of consciousness to prevent serious and potentially life-threatening side effects such as methemoglobinemia (a condition that can deprive tissues and organs of oxygen), central nervous system reactions (e.G., convulsions, unconsciousness, coma, respiratory arrest), and cardiovascular disorders (e.G., low blood pressure, heart block, irregular heart rhythm, cardiac arrest). Patients require immediate medical attention if they develop signs and symptoms of methemoglobinemia such as pale, gray, or blue colored skin (cyanosis); headache; rapid heart rate; shortness of breath; lightheadedness; or fatigue.